After leaving pediatric emergencies, 20% of parents do not feel sure they can take care of their child: study

A cross-Canada study of the emotional needs of parents who bring their children to pediatric emergency departments shows that a significant number leave unsatisfied and unsure about how to care for their child after discharge.

In research recently published in PLOS ONE conducted in 10 Canadian children’s hospitals, the study team reports that 30% of parent caregivers have unmet emotional needs, 15% have unmet communication needs, and 15% feel insufficiently involved in their child’s care .

Although approximately 85% of parents report feeling good or very good in their interactions with doctors and nurses, only 81.8% subsequently feel comfortable caring for their child at home.

“The central theme is: ‘I’m afraid, for my child and for me,’” explains Samina Ali, emergency pediatrician, professor of pediatrics and assistant professor of emergency medicine at the Faculty of Medicine and Dentistry. “They tell us, ‘I need you to inform me about my child’s condition. I need you to make sure that my child is included in this process and that I have enough information to take take care of him when I get home.'”

“While the results are very positive in some ways, they indicate that we can still do work together to improve the experience for families,” says Shannon Scott, professor and interim dean of the Faculty of Nursing and former Chair of Nursing. Canadian research on knowledge translation in children. Health.

“I think these results will be very compelling for decision-makers in health care settings because they will help them allocate resources and design additional services and supports for families,” Scott says.

Stress on families, stress on the system

The study was the brainchild of Ali, who asked Scott to participate because she is an expert in engaging families in research and creating health education materials for parents , then called on Pediatric Emergency Research Canada, a network of more than 200 pediatric emergency physicians and researchers in every pediatric hospital in Canada.

More than 2,000 family caregivers, 74% of whom were mothers, agreed to participate in the study between October 2018 and March 2020. They completed a survey while in the emergency room and another within seven days afterward. their discharge from the hospital. The average age of parents was 37.8 years and that of children 5.9 years.

Parents were more likely to say their needs were met if they felt their questions were answered, their child’s privacy was respected, and they received regular updates about their child’s care. child. Parents of the sickest children were the most satisfied, while parents of the least ill children were least likely to be satisfied – a circumstance, Ali and Scott say, that is likely due to medical staff spending more time time with the most seriously ill children.

Scott and Ali emphasize that better care is possible despite pressures on staff due to long wait times in overcrowded emergency departments.

“We cannot control the number of RSV cases in the community, but what we say and what we do is within our control,” says Ali. “If I am better trained to meet the emotional and communication needs of parents, it will improve the experience for each family. It could also reduce stress on the system as they leave feeling cared for and safe and knowing what to do when they return home or for the next illness.”

Ali notes that the research team has already identified that caregiver stress is associated with early returns to pediatric emergency departments. The new findings to be released this year seek to shed light on how parents’ health knowledge affects non-emergency use of emergency services. Health literacy is a measure of the extent to which a person understands and acts on health information they receive from medical personnel.

“In one in three families I meet, the caregiver does not have enough health knowledge to understand the information I give them,” Ali says. “If we can, at a public health level, increase our national health literacy, that will likely also affect the use of our services, because we see that caregivers with low health literacy are one and a half times more likely to have non-urgent care ED use.”

Take the time to do a simple update

Parental anxiety can negatively influence a child’s development and mental health, Ali points out, and non-emergency visits to the emergency room can expose the child to germs in the waiting room.

Both Scott and Ali believe that small changes in the behavior of emergency department staff could have a big influence.

“Take 10 to 20 seconds between patients to tell families, ‘I haven’t forgotten you,’” Ali advises. “‘I’m waiting for a test result – your child is not anemic, now I’m just waiting for their urine results to come back or whatever. This 30 second update can make all the difference in how this family perceives their entire emergency room visit.

“With the current pressure in emergency departments, the lack of staff and the volume of cases, we are starting to make decisions about what we can and cannot do,” says Scott. “These results tell us that these activities are highly valued, so they are worth our time and investment.”

“We can never overlook the importance of emotionally supporting families whose children are seriously ill.”